New Study Looks At Covid-19 Risk In Child Care Workers


When the pandemic was in its infancy, real infants were sent home. Daycare facilities, child care centers, and preschools across the country closed precipitously, leaving millions of families scrambling to figure out what that Zoom app was, all while trying to keep toddlers away from webcams and dongles. While many daycare facilities closed, many child care centers, in all 50 states, either closed only briefly or didn’t close at all. The likelihood of young children and infants being Covid-19 “superspreaders” remains unclear, and to date, the majority of children who have contracted Covid-19 infections have been asymptomatic or very mildly symptomatic. That said, a rare post-inflammatory syndrome, MIS-C (Multisystem Inflammatory Syndrome in Children) has raised more substantial concerns regarding children’s immune response to Covid-19.

study published in Pediatrics looked at the incidence and risk factors associated with Covid-19 infections in adults caring for children in child care centers in the early months of the pandemic

    The investigators, based at Yale, surveyed child care facility workers who had worked with children under age 6 years during the early months of the Covid-19 pandemic. In this study, information from April 2020 through the end of May 2020 was considered. In all, they included over 57,000 adult individuals from all 50 states, Puerto Rico, and the District of Columbia. Providers were asked about the location of their facility, age ranges of children, courting practices, mask use, temperature checks, and cleaning practices. Questions about Covid-19 infections, hospitalizations, and complications were included, as well as demographic variables such as gender, race, and ethnicity of the facilities’ populations.

    In the early months of the pandemic, the cumulative incidence of Covid-19 in the U.S. adult population was approximately 0.8%. With that, one could expect that approximately 450 child care workers (0.8% of 57,o0o) would become infected with Covid-19, assuming there was no increased risk by continuing to work in these environments. Indeed, this was the case. There was no added risk of contracting Covid-19 to adults working in child care centers in the early months of the pandemic.

    Surprisingly, relatively few children (11%) wore masks at all times, and only 35% of the adult caregivers wore masks. As the surveys included data from April and May 2020 (prehistoric times, in Covid-19 time), it is likely that these low numbers of mask wearers corresponded to the overall population prevalence of mask-wearing during those early months, especially in children. Symptom screening and temperature checks were performed once (and in many centers twice) daily, and surface disinfection occurred twice (and in many centers three times) daily. The overwhelming majority (greater than 90%) of children and staff washed hands multiple times throughout the day.

    The highest contributing factor to the incidence of Covid-19 infections (in adults, which this study solely addressed) was the overall community prevalence of Covid-19 at any given time. As many K-12 schools across the country are finding ways to manage Covid-19 exposure, prevent outbreaks, and maintain layers of safety and protection for both students and staff while safely remaining open, this study lends additional information regarding the importance of gauging the potential for opening based on a given community’s Covid-19 prevalence.

    New York City public schools, with over 1.1 million children, have reported only 18 new cases of Covid-19 in the first three weeks of partial re-openings. The 7-day average test positivity rate for Covid-19 in New York City as of October 17, 2020, was 1.6%. While standardization for identifying and tracing new Covid-19 cases continues to be a work in progress, this model, on a more local but much larger scale than daycare openings, seems to be following a similar pattern of case rate commensurate with community spread. As Fall 2020 is already leading to spikes of cases throughout most of the country, spikes in schools and child care facilities may follow suit.

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